Optimal duration of exclusive breastfeeding
RHL practical aspects by Sguassero Y
FIRST CONTACT (PRIMARY CARE) LEVEL
It is of paramount importance to ensure that each time mothers and babies come into contact with health services they receive appropriate feeding support from health-care providers. In developing countries, dietary advice during pregnancy with provision of adequate quantities of iron-rich foods and/or iron or folate supplementation may prevent deterioration of anaemia in women (1). The physical growth and development of young children, regardless of how they are fed, should be carefully monitored and appropriate and feasible interventions should be implemented whenever clinically indicated.
Ideally, breastfeeding support should be provided as part of routine primary health-care service provision. This implies, among others things, the need for skilled health-care workers, peer-trained counsellors and certified lactation consultants to help the mothers with their feeding technique and to prevent or resolve their breastfeeding problems. The Baby Friendly Hospital Initiative, which was launched in 1991, has evolved into a series of trainings and assessments, with the result that over 19,000 hospitals around the world have been designated baby-friendly. Based on this initiative, 10 steps to successful breast feeding are described below:
- Have a written breastfeeding policy and communicate it routinely to health-care staff.
- Train all health-care staff in skills necessary to implement this policy.
- Inform all pregnant women of the benefits of breastfeeding and how to carry it out successfully.
- Help mothers to initiate breastfeeding within a half an hour of birth.
- Show mothers how to breastfeed, and how to maintain the flow of breast milk even if they need be separated from their infants.
- Give newborn infants no food and drink other than breast milk, unless medically indicated.
- Practice rooming-in – allowing mothers and infants to remain together – 24 hours a day.
- Encourage breastfeeding on demand.
- Give no artificial teats or pacifiers (i.e. dummies or soothers) to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
In case of special situations such as HIV infection, mothers need counseling to know the benefits, risks and costs associated with all infant-feeding options. They have to make an informed choice and they may need to be referred to a hospital for individual counseling and treatment. Furthermore, if an HIV-positive woman exclusively breastfeeds, the risk of the child being infected via breastfeeding is substantially reduced (2).
At home or in the community
In under-resourced settings, developing long-term breastfeeding support systems in targeted communities is a major challenge. The practical implementation of large- scale community-based breastfeeding interventions demands substantial resources jointly with social and political commitment to ensure improvements in breastfeeding practices over time.
- Cuervo LG, Mahomed K. Treatments for iron deficiency anaemia in pregnancy. The Cochrane Database of Systematic Reviews. Issue 2. Art. No. 2001;CD003094: 10.1002/14651858.CD003094.
- HIV transmission through breastfeeding: a review of available evidence. Geneva: World Health Organization; 2004.
This document should be cited as: Sguassero Y. Optimal duration of exclusive breastfeeding: RHL practical aspects (last revised: 28 March 2008). The WHO Reproductive Health Library; Geneva: World Health Organization.